Researchers used Swedish national registries to identify 3,240 patients with bipolar disorder who started treatment with an antidepressant and had no antidepressant treatment during the previous year. Patients were categorized into those receiving antidepressant monotherapy and those receiving an antidepressant plus a mood stabilizer. The researchers compared the rate of mania 0–3 months and 3–9 months after the start of antidepressant treatment with a preceding nontreatment period.

Nearly 35 percent of the patients were treated with antidepressant monotherapy. The increased risk of treatment-emergent mania—with a hazard ratio of 2.83—was confined to patients on antidepressant monotherapy. Among patients treated with a concurrent mood stabilizer, no acute change in risk of mania was observed during the 3 months after the start of antidepressant treatment, and a decreased risk was foiund during the period 3–9 months after treatment initiation.

Michael Thase, M.D., a psychiatrist at the University of Pennsylvania and one of the study co-authors said that even though current practice guidelines recommend using antidepressants in combination with mood stabilizers in bipolar disorder patients, in Europe the practice of monotherapy is not uncommon. "Our findings suggest that antidepressants alone are associated with increased manic switching, and when it happens it happens pretty quickly," he told Psychiatric News. "The converse finding is that patients who got mood stabilizers while treated with antidepressants not only did better in the short term but had an improved course in the long run. This means if you can prevent cycling or switching to any degree, your patients have a better chance of staying well over the long-term."

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